Acetabular de-escalation in hip revision

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Fabrizio Rivera
Alessandro Bardelli
Pietro Maniscalco
Andrea Giolitti


hip revision, de-escalation technique, Burch Schneider cage


Background: The idea of ‘‘de-escalation’’ (DE) indicates an arthroplasty revision performed by changing a revision component by a primary component. Aim of this study is to verify if this technique can represent an option in case of cage or ring failure. Methods: We observed five cases of revision hip cage loosening with complete allograft consolidation. This group of patients were revised with use of a primary cup and were specifically followed in ours institutions offices. Patients were clinically and radiologically followed every 6 months for the next two years and then annually Results: At final follow-up (15-2 years, mean 6 years) four patients (80%) showed a good recovery of their levels of activity. The mean Harris hip score improved from 20 points (range,7-38 points) preoperatively to 48 points (range, 16-88 points). At final radiological follow-up acetabular components were radiographically stable at the last follow-up. One patient (20%) at two years follow-up, was unable to walk without crutchies due to hip pain. X-rays showed cup loosening in all three zones. Patient was dissatisfied. Primary cup was revised with a Burch Schneider cage. Conclusions: De-escalation technique is a surgical option to consider in case of young patients, limited number of previous revisions and more than three years survivorship of loosened acetabular cage.


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1. Miletic B, May O, Krantz N, Girard J, Pasquier G, Migaud H. De-escalation exchange of loosened locked revision stems to a primary stem design: complications, stem fixation and bone reconstruction in 15 cases. Orthop Traumatol Surg Res. 2012;98(2):138-43.
2. Mencière ML, Wissocq N, Krief E, Elkoun D, Taviaux J, Mertl P. Mid-term outcomes after distally locked-to-standard primary stem exchange in 29 hip-prosthesis patients. Orthop Traumatol Surg Res. 2014;100(1):135-40.
3. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-75.
4. Morscher E, Dick W, Seelig W. Revision arthroplasty of the hip joint with autologous and homologous cancellous bone. Orthopäde 1989;18:428-37.
5. Goodman S, Sastamoinen H, Shasha N. Complications of ilio-ischial reconstructions rings in revision total hip arthroplasty. J Arthroplasty 2004; 19:436–46.
6. Gill TJ, Sledge JB, Mueller ME. The Burch–Schneider anti-protrusio cage in revision hip arthroplasty. Indications, principles and long-term results. J Bone Joint Surg 1998; 80:946–953.
7. Saleh KJ, Jaroszynski G, Woodgate I. Revision total hip arthroplasty with the use of structural acetabular allograft and reconstruction ring. A case series with a 10 year average follow-up. J Arthroplasty 2000; 15:951–958.
8. Eggli S, Muller C, Ganz R. Revision surgery in pelvic discontinuity. An analysis of seven patients. Clin Orthop 2002; 398:136–145.
9. Gross AE, Goodman SB. Rebuilding the skeleton. The intraoperative use of trabecular metal in revision total hip arthroplasty. J Arthroplasty 2005; 20:91–93.
10. Dennis DA Management of massive acetabular defects in revision total hip arthroplasty. J Arthroplasty 2003; 18:121–125.
11. Buma P, Lamerigts N, Schreurs BW, Gardeniers J, Versleyen D, Slooff TJ. Impacted graft incorporation after cemented acetabular revision. Acta Orthop Scand 1996 Dec;67(6):536-40.
12. Vivès P, Plaquet JL, Leclair A, Blejwas D, Filloux JF. Revision of interlocking rod for loosening of THP. Concept–preliminary results. Acta Orthop Belg 1992;58:28—35.
13. Gill TJ, Siebenrock K, Oberholzer R, Ganz R. Acetabular reconstruction in developmental dysplasia of the hip results of the acetabular reinforcement ring with hook. J Arthroplasty 1999;14(2):131–7.
14.  Gurtner P, Aebi M, Ganz R. The acetabular roof cup in revision arthroplasty of the hip. Z Orthop Ihre Grenzgeb 1993;131(6):594–600.
15.  Schlegel UJ, Bitsch RG, Pritsch M, Aldinger PR, Mau H, Breusch SJ. Acetabular reinforcement rings in revision total hip arthroplasty midterm results in 298 cases. Orthopade 2008;37(9):904–906-13.
16. Hsu CC, Hsu CH, Yen SH, Wang JW. Use of the BurcheSchneider cage and structuralallografts in complex acetabular deficiency: 3- to10-year follow up Kaohsiung J Med Sci.2015;31(10):540-7
17. Abolghasemian M, Drexler M, Abdelbary H, Sayedi H, Backstein D, Kuzyk P, Safir O, Gross AE. Reconstruction of massive uncontained acetabular defects using allograft with cage or ring reinforcement Bone Joint J. 2013;95-B(6):777-81. 
18. Maruyama M, Wakabayashi S, Ota H, Tensho K. Use of the Burch-Schneider cage and structural allografts in complex acetabular deficiency: 3- to 10-year follow up. Clin Orthop Relat Res. 2017;475(2):387-395